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BVetMed3 POS - Principles Of Oncology > Principles Of Oncological Surgery > Flashcards

Principles Of Oncological Surgery Flashcards

1
Q

Why is it important to biopsy as large a section of tissue as possible?

A

Bigger piece of tissue + better chance of correct diagnosis

Smaller bits of tissue increases risk of sampling error

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2
Q

What are the advantages of surgical tumour resection?

A 
Immediate cure 
Not carcinogenic 
No toxic effects 
Not immunosuppressive 
Better for large masses
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3
Q

What are the disadvantages of surgical excision?

A

Local cure only
Change in cosmesis
Change in function

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4
Q

What steps do you need to take to plan surgical excision?

A

histologically diagnosis

Assess extent of local disease

Look for presence of local or distant metastasis

Assess the nutritional status of the patient

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5
Q

What is the best method to assess the presence of local or distant metastasis?

A

CT

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6
Q

Why is it important to assess the nutritional status of the patient before sx?

A

May want to build nutritional management into treatment plan e.g. feeding tube

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7
Q

When in the course of disease would you aim to surgically excise a tumour ?

A

Early

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8
Q

Which surgery has the best chance of success?

Why?

A

The FIRST ONE

Anatomy gets distorted by the first sx

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9
Q

What should not influence decisions relating to margins?

A

Concerns regarding closure

In practice?

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10
Q

Where are the most active and invasive parts of a tumour located?

A

PERIPHERY

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11
Q

When should biopsy be performed?

A

If the treatment plan would be changed

  • type of tx
  • extent of tx

If owner’s decision would be changed
- tumour type/grade, clinical stage, prognosis

If lesion in difficult area - head + neck, distal limb

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12
Q

When might biopsy not be indicated?

A

Mass in thorax

  • DDx : primary tumour, lung lobe abscess, fungal granuloma
  • all tx with excisional surgery

Solitary pulmonary nodule
- excisional biopsy - curative (of primary) + diagnostic -
Don’t need to know prior to sx

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13
Q

Which has a better survival time: an osteosarcoma or a chondrosarcoma?

A

CHONDROSARCOMA - 3-4 years

Osteosarcoma ~6 months

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14
Q

When would biopsy not be indicated?

A

Treatment plan would not be changed

  • mammary mass excisions
  • single large lung mass lobectomy

No change in owner’s willingness to treat
- chest wall sarcoma resection

Biopsy is as difficult as sx
- CNS mass lesions, thyroid tumours, small intestine tumours

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15
Q

Why might you not biopsy thyroid tumours?

A

Very vascular

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16
Q

What are the types of biopsy?

A

Needle
Incisional
Excisional

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17
Q

What are the types of needle biopsy?

A

FNA

Core - tru-cut

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18
Q

What limitations are associated with FNAs?

A

False negatives common

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19
Q

What are FNAs good at diagnosing?

A

MCT, lymphoma

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20
Q

What issue is associated with core/tru-cut biopsy?

A

Might just get a lot of necrotic tissue.

21
Q

What are the types of incisional biopsy?

A

Surgical
Grab biopsy
Punch biopsy

22
Q

What should you bear in mind when performing an incisional biopsy?

A

Biopsy in a way that won’t compromise excision surgery later

E.g. biopsy jaw tumours through oral cavity

23
Q

Why should you punch biopsy at the edge of a lesion?

A

To get the transitional zone

24
Q

How can you reduce contamination when excising a tumour?

A
  • Avoid entering the pseudocapsule (contains tumour cells)
  • Manipulate tumour gently (use atraumatic forceps)
  • Isolate tumour from body cavity
  • Resect adhesions between tumour and normal tissue
  • Lavage the surgery site - removes blood, necrotic tissue, foreign material
  • Change gloves and instruments
25
Q

How should you manage the blood vessels during sx?

A

Reduce blood flow to reduce embolic spread

VEINS - prevents venous emboli (still spread via lymphatic

ARTERIES - prevents haemorrhage, prevents organ congestion, reduced arterial supply = reduced venous outflow

26
Q

How can you tell if metastasis to a LN has occurred?

A

Can ONLY tell for certain by excising the whole LN and using microscopy

27
Q

When should you remove a regional LN?

A

LN is positive for tumour and not fixed to another tissue
LN is grossly abnormal at sx
LN intimately attached to excised tissue

Also if associated with therapeutic benefit

28
Q

When should you NOT remove a regional LN?

A

If LN fixed to critical adjacent tissue
- e.g. Bronchial LNs closely associated with vessels

If uncertain as to whether positive for tumour

(then biopsy indicated)

29
Q

What are the types of local metastasis that may surround a tumour?

A

Satellite metastasis (closer to tumour)

Skip metastasis

Finger like projection

30
Q

What are the aims of margins of excision?

A

Removal of the tumour and a margin of normal tissue

31
Q

What are typical margins taken?

A

3-5 cm around,

1 fascial plane deep

32
Q

What is the pseudocapsule?

A

A zone of compressed tissue around the tumour.

Contains viable tumour cells

DO NOT ENTER WHEN EXCISING

33
Q

When would you consider ‘shelling out’ a tumour?

A

Very large lipomas between muscle bellies

34
Q

What is local excision?

A

Tumour removed through the natural capsule or immediate boundaries

35
Q

When is local excision indicated?

A

Benign tumours and NO local invasion

E.g. lipoma, histiocytoma, sebaceous adenoma

To preserve adjacent tissue
E.g. thyroid adenoma or CNS

36
Q

When is local excision contraindicated?

A

Local invasion

Malignancy

37
Q

What is wide local excision?

A

Tumour removed with substantial margin of normal tissue

38
Q

When is wide local excision indicated?

A

Benign tumours / local invasion

Malignancy/ limited local invasion

39
Q

What margins would be indicated for a SCC or benign oral tumour?

A

1cm

40
Q

What margins would be indicated for a MCT or ST sarcoma?

A

2-3cm

41
Q

When is wide local excision contraindicated?

A

More invasive malignancies

Higher grade tumours

42
Q

What is radical excision?

A

Margins extend into fascial planes undisturbed by tumour growth

43
Q

When is radical excision indicated?

A

Malignancy

Local invasion

44
Q

What are the four types of radical excision?

A

Radical local
Compartmental
Muscle group excision
Amputation

45
Q

What is radical local excision?

A

Tumour removed with extensive margins of tissue including one or two fascial planes beyond gross tumour

46
Q

When might radical local excision be indicated?

A

Invasive sarcoma of the abdominal or chest wall

Invasive carcinoma of nasal plan up

Invasive tumours involving eyelids

Invasive orbital/periorbital tumours

47
Q

What is compartmental excision?

A

Tumour is removed in an intact anatomic compartment

E.g. tumour inside muscle belly —> excise muscle

48
Q

When is amputation indicated?

A

Large tumours
If radical excision impairs function - e.g. bone/joint

Management of recurrences - disturbed fascial planes

BVetMed3 POS - Principles Of Oncology (5 decks)

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